PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
INTEGRATED ACTIVITY FLAG:
This University Research Co., LLC/Quality Assurance Project (URC/QAP) PMTCT activity is linked to activities in Basic Health Care and Support (#7429), TB/HIV (#7430), Counseling and Testing (#7432) and ARV Services (#7428).
SUMMARY:
Through training, mentoring and the introduction of quality assurance (QA) tools and approaches, University Research Co., LLC/Quality Assurance Project (URC/QAP) will assist 130 South African Dept of Health (DOH) facilities in five provinces to improve the quality of PMTCT and follow-up services. URC/QAP will capacitate healthcare workers to ensure rapid identification and referral of HIV-infected pregnant women and their babies to appropriate services. The essential elements of QA include technical compliance with evidence-based norms and standards, interpersonal communication and counseling and increasing organizational efficiency. The major emphasis areas for this activity are QA and supportive supervision, with minor emphasis on development of networks, linkages, referral systems, training and needs assessment. The target populations include people living with HIV, HIV-infected pregnant women, HIV and AIDS affected families, HIV-infected infants, HIV-infected children, policy makers, public and private healthcare workers, community-based organizations (CBOs), and NGOs.
BACKGROUND:
URC/QAP has been supporting PMTCT programs in 120 facilities in four provinces. URC/QAP has also supported two home-based care organizations (HBOs) to improve the quality of their home-based care program targeting HIV-infected mothers and their babies. A collaborative model has been used to rapidly expand access to PMTCT services in a large number of antenatal care (ANC) facilities. In FY 2007, URC/QAP plans to expand the program to a total of 130 facilities and assist health facilities to integrate PMTCT with ANC services and improve postnatal follow-up of babies. This is a major area of concern as most HIV-exposed babies do not receive follow-up care. URC/QAP will assist healthcare facilities in integrating follow-up strategies into postnatal/well-baby services. Appropriate changes will be made and monitored to ensure implementation and compliance with national guidelines in all 130 facilities. URC/QAP coordinators will facilitate training in integrating clinical practices. Counseling on infant feeding, appropriate opportunistic infection prophylaxis and mother-baby follow-up will be improved. URC/QAP will continue to provide support to additional CBOs to improve the quality of their services to peripartum women. Support will focus on improving infant feeding practices and follow-up care of HIV-infected infants. URC/QAP will work with district supervisors to ensure that they provide ongoing support and mentoring to healthcare workers.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: Establish Facility-level Quality Improvement Teams
URC/QAP will work with each facility to identify core teams representing various service delivery components such as ANC, and HIV Care and Treatment. Facility teams, with URC/QAP and DOH staff support, will be responsible for developing facility-based plans for increasing the uptake and quality of PMTCT services. Each facility team will conduct regular rapid assessments to identify and address quality gaps. Assessments will be conducted by using standardized quality assurance (QA) tools based on NDOH standards. URC/QAP will assist each facility team to develop a strategic plan for improving the uptake of PMTCT and follow-up services. Interventions will include: (1) use of QA tools to improve compliance with national and provincial guidelines; (2) re-design of clinical processes to improve patient flow and service times; and (3) train facility teams to analyze their performance and compliance in relation to standard indicators. URC/QAP will engage in social mobilization activities to address issues of psychosocial support, stigma reduction and prevention of domestic violence for HIV-infected pregnant women. These would involve working with communities, CBOs, and HBOs to improve the visibility of PMTCT activities: increasing VCT in communities by education (in facilities and door-to-door/household visits); and hosting open days for clinic staff and community members, to showcase improvement activities and encourage support for improvement
initiatives.
ACTIVITY 2: Referrals and Linkages
URC/QAP will facilitate linkages to treatment for eligible women and their infants by ensuring training and compliance of facility staff with national guidelines and implementing quality improvement plans including process re-design, integration of services, and enhancement of network development with CBOs to improve referral patterns. URC/QAP will strengthen the ability of healthcare workers to provide infant care follow-up, opportunistic infection (OI) prophylaxis, and basic preventive care to HIV-exposed infants identified in the PMTCT programs. URC/QAP will continue to promote improvements in counseling of mothers regarding infant follow-up and best practices, early infant diagnosis, ongoing training and onsite mentoring, and support for national initiatives. URC/QAP plans to strengthen linkages to Orphans and Vulnerable Children (OVC) programs and to routine maternal and child health services, including family planning. It is envisaged this will serve to identify and strengthen existing networks; highlight gaps in the quality of services provided; and provide information about the feasibility of incorporating relatively rapid QA approaches into ongoing OVC programs.
ACTIVITY 3: Strengthening Supervision
URC/QAP will visit each facility at least twice a month to provide on-the-job support and mentoring to healthcare workers in participating facilities. The mentoring will focus on improving clinical skills of staff and ensuring that the improvement plans are implemented correctly. During these visits, URC/QAP and facility staff will compare performance data with expected results. URC/QAP will conduct quarterly assessments in each facility to assess whether the facility staff is in compliance with the national guidelines. At least once a year, sample-based surveys will be done in a small number of QAP-assisted facilities to assess compliance with quality assurance standards and other key performance indicators. URC/QAP will train district and facility-level supervisors in QA methods and develop supervision techniques to improve the sustainability of QA within the PMTCT program.
Although the coverage area for the URC/QAP PMTCT project is primarily Eastern Cape, KwaZulu-Natal, Limpopo, North West, and Mpumalanga, some activities are also directed at the national level. URC/QAP will actively participate in the training and development of the National NDOH PMTCT monitoring and evaluation framework, in collaboration with NDOH staff, to ensure accountability and long-term sustainability of the program. URC/QAP will advocate for strategies to address male norms and behaviors (Key Legislative Area) specifically seeking their involvement in PMTCT and highlight the importance of partner testing at all levels. Male involvement in the URC/QAP PMTCT program involves sensitizing staff to the importance of male testing and participation in PMTCT programs. Male counselors are being trained at some facilities, to enhance the current system. Promoting integration of services at the facility level ensures the development of links between services such as sexually transmitted infections, family planning and VCT, promoting holistic care.
URC/QAP will contribute to 2-7-10 PEPFAR goals by ensuring a strengthened PMTCT program, including rapid identification and referral of HIV-infected pregnant women and their babies to appropriate services and assuring quality service delivery, thus reducing the number of mother-to-child infections.
INTEGRATED ACTIVITY FLAG: This activity relates to University Research Co., LLC / Quality Assurance Project activities in PMTCT (#7431), TB/HIV (#7430), Counseling and Testing (#7432) and ARV Services (#7428). This partner may benefit from the Partnership for Supply Chain Management ARV Drugs activity (#7935), which will explore current pain and symptom management practices, drug availability and cost, and provide recommendations.
SUMMARY: University Research Co. LLC/Quality Assurance Project (URC/QAP) will support 80 Department of Health (DOH) facilities in 5 provinces to improve the quality of basic health care for People Living With HIV (PLHIV) by improving compliance of healthcare workers with treatment guidelines. The essential elements of Quality Assurance support include technical compliance with evidence-based norms and standards, interpersonal communication and counseling and increasing organizational efficiency.
The major emphasis area for this activity is quality assurance/supportive supervision, with minor emphasis on development of network/linkages/referral systems, training and policy/guidelines. The activity targets public health workers, program managers, volunteers and PLHIV. These activities will result in improving the continuum of care for adults and children living with HIV and their families as they pass through different stages of the disease or through different levels of healthcare system ensuring that they receive high quality services.
BACKGROUND: URC/QAP currently works with 70 DOH facilities in four provinces improving the quality of basic healthcare and support services for PLHIV. In FY 2007 the number of DOH facilities that URC/QAP mentors will be expanded. In FY 2007, URC/QAP will work with the South Africa (SA) DOH and Department of Social Development, community-based organizations/home-based organizations (CBOs/HBOs) and other PEPFAR partners to ensure the delivery of comprehensive family-centered services for PLHIV. Using Quality Assurance (QA) tools based on DOH standards and guidelines, URC/QAP will help facilities provide an essential package of activities to ensure that PLHIVs receive high quality basic healthcare and support services. Temporary medical staff will be made available to healthcare facilities to initiate and strengthen provision of basic health services for PLHIV. URC/QAP will also work with HBOs/CBOs to improve home-based care services by linking home-based caregivers to facilities. It is envisioned that URC/QAP activities will support integrated programming in a network of services for all HIV-infected clients and their families by integrating preventative messages and condoms into HIV and AIDS care activities, screening and referral for PLHIV to other service delivery areas, stigma reduction activities and involvement of community/home-based care givers to promote adherence to ART and anti-Tuberculosis (TB) regimens.
ACTIVITIES AND EXPECTED RESULTS: ACTIVITY 1: Establish Facility-level Quality Improvement Teams URC/QAP will work with each facility to identify core teams representing various clinical services. These teams, with support from URC/QAP and district staff, will be responsible for implementing plans for improving access to quality basic primary healthcare and support services for PLHIV, particularly issues pertaining to equitable access for women and girls/related gender considerations. Each team will conduct baseline assessments to identify and address quality gaps in clinical services. These assessments will be used by the facility teams to develop and implement a quality improvement plan.
URC/QAP will assist facility teams in developing and implementing strategic plans for improving access to quality healthcare services. URC/QAP activities will focus on improving preventative care services for PLHIV and their families, including access to HIV counseling and testing services, TB/OI screening and provision of cotrimoxazole prophylaxis. URC/QAP will monitor staff interventions to provide high quality services in nutrition counseling, diarrhea management, screening for pain and symptoms, treatment for OIs and ARV services, home-based support, social service linkages and community-based ART follow-up and adherence support, in accordance with national guidelines. URC/QAP will facilitate linkages to treatment and care for eligible clients by training facility staff on the need for treatment referrals. Effort will be made to ensure equitable access to care services for both males and females (key legislative area). URC/QAP will work with facility staff to design and implement referral plans and strengthen the development of networks with CBOs/HBOs to improve referral patterns.
URC/QAP activities at facility level will include an integration of key HIV and AIDS prevention messages and provision and referral for condoms into all care activities. At national and provincial levels, URC/QAP will continue to collaborate with the NDOH on the development of infection control guidelines, emphasizing measures such as good hygiene practices and use of safe water for PLHIV. At a community level, CBOs/HBOs linked to DOH facilities will be assisted to provide home-based care services to PLHIV and expand outreach services to the community. URC/QAP will also train facility and CBO/HBO staff in pain and symptom management for all PLHIV, including basic assessment and management of common pain and symptoms related to HIV disease and appropriate use of the WHO analgesic ladder and referral when necessary.
ACTIVITY 2: Human capacity development URC/QAP will train facility staff in QA strategies, specific to basic health care. In addition, job-aids and wall charts will be provided to improve compliance with clinical and counseling guidelines. All training will be in accordance with the SA National DOH training guidelines for community and home-based care, HIV and AIDS Care and Treatment Guidelines and PMTCT guidelines for pediatric care. At the community level, URC/QAP will fund and capacitate CBOs/HBOs to better utilize community health workers and strengthen the capacity of families and community members to meet the needs of PLHIV.
ACTIVITY 3: Strengthening supervision URC/QAP will visit each facility/CBO at least twice a month to provide onsite mentoring to healthcare workers. This will focus on improving clinical skills of staff as well as ensuring that improvement plans are being implemented correctly. During these visits URC/QAP will also review program performance data to ensure expected results are being achieved. URC/QAP will conduct quarterly assessments in each facility/CBO/FBO to assess whether staff is compliant with national guidelines. To ensure staff is being supported on an ongoing basis and promote sustainability, URC/QAP will train district, facility-level, and CBO supervisors in QA and facilitative supervision techniques.
Activity #4 Plus up to funds will provide assistance with set up, running and facilitation of care support groups at all QAP-supported health care sites in the five provinces. The focus will include Prevention with Positives (PWP), wellness programs & care for the caregiver's activities.
Activity # 5 Plus up funds will also be used to support and improve support and care services provided to families of PLWHA. To this end, staff at URC/QAP-supported facilities and home-based care organisations will be encouraged and mentored on the importance of provision of clinical / physical, psychological, spiritual or social services to families of PLWHA. URC/QAP staff will focus on identification of clinical / social needs within these families and the development of appropriate referral linkages and networks.
This activity contributes to the PEPFAR target of 10 million people in care. URC/QAP will assist PEPFAR in reaching the vision outlined in the USG/South Africa Five-Year Strategy by improving the continuum of care for PLHIV.
This University Research Co., LLC / Quality Assurance Project (URC/QAP) in the TB/HIV (#7430) activity is linked to activities in PMTCT (#7431), Basic Health Care & Support (#7429), Counseling and Testing (#7432) and ARV Services (#7428).
University Research Co., LLC / Quality Assurance Project (URC/QAP) will work with the Department of Health (DOH) through training, mentoring and introduction of quality assurance (QA) tools/approaches to improve the quality of services for Tuberculosis/HIV (TB/HIV) co-infected patients in 80 DOH health facilities in 5 provinces. The essential elements of Quality Assurance support include technical compliance with evidence-based norms and standards, interpersonal communication and counseling and increasing organizational efficiency The major emphasis area for this activity is quality assurance/supportive supervision with minor emphasis on development of network/linkages/referral systems, training and needs assessment. The activity targets public health workers, NGOs and community leaders, program managers, volunteers and People Living With HIV (PLHIV).
Since 2001, URC/QAP has worked with the DOH to improve the quality of TB services. A number of challenges continue to hamper the TB/HIV program, including provider knowledge and skills about TB, poor access to laboratories and supervision. The rising TB burden in South Africa (SA) is further complicated by an escalating HIV incidence. These dual epidemics necessitate the development of creative strategies to address TB/HIV as a single entity and develop suitable service delivery models. URC/QAP will assist 85 health facilities in 5 provinces to improve screening, referral, treatment, and follow-up of PLHIV to identify those co-infected with TB in line with NDOH standards and guidelines. URC/QAP will assist facilities offering HIV services to better integrate TB screening and treatment services into their programs URC/QAP will also provide small grants to selected local Community-based Organizations/Home-based Organizations (CBOs/HBOs) to integrate TB screening, referral and follow-up into their home-based care programs for PLHIV.
Activity 1: Establish Facility-Level Quality Improvement Teams
URC/QAP will work with each facility to identify core teams representing TB and HIV service providers as well as other staff. These teams, with support from URC/QAP coordinators and district staff, will be responsible for implementing facility plans for improving access to TB screening, treatment and follow-up among PLHIV. Each facility team along with URC/QAP staff will conduct rapid ongoing assessments to identify and address quality gaps in current services for screening, treating and following up of PLHIV for TB. URC/QAP will assist the facility teams in the 5 provinces to increase HIV counseling and testing (CT) for TB patients, utilizing various models for CT, including provider-initiated CT with opt-out option. URC/QAP will assist teams in developing a strategic plan for improving access to quality TB services for PLHIV at all levels, including provision of cotrimoxazole prophylaxis for co-infected HIV/TB patients. URC/QAP will facilitate linkages to ARV treatment for eligible clients by training facility staff on the NDOH National guidelines; and training facility staff in QA methods specific to TB and HIV; designing with facility staff referral improvement plans, including strengthening networks with CBOs/HBOs to improve referral patterns. URC/QAP is already in the process of developing a continuum of care model to ensure cross referral, with improved case finding/case detection rates, and continuity of care, with improved follow up and DOTS support for all HIV/TB co-infected patients. Emphasis will also be placed on DOTS support/treatment adherence to prevent multi-drug resistant TB among PLHIV. At the national level, URC/QAP will continue assisting the South Africa National Tuberculosis Control Program (NTCP) in the implementation of the NDOH guidelines for management of HIV-infected TB patients.
Activity 2: Training
URC/QAP will train health care providers to screen all HIV-infected clients for symptoms of active TB and support referral of all TB suspects for diagnosis and treatment. In collaboration with facility staff, URC/QAP will support "fast-tracking" of clients with TB symptoms for appropriate diagnostic tests to assure timely treatment and to reduce the risk of nosocomial transmission to susceptible PLHIV. URC/QAP will also work with facility staff on the development of a "retrieval" or back-referral system to assure that TB patients continue to access HIV-care within facilities and CBOs/HBOs.
Activity 3: Human Capacity Development
URC/QAP will provide job-aids such as wall charts to improve compliance with national TB guidelines. URC/QAP will work with CBOs/HBOs to develop strategies for providing TB screening, referrals and DOT support as part of their home-based programs. URC/QAP will train facility and CBO/FBO staff in analyzing their performance (outputs) and quality (compliance) indicators. On a monthly basis staff will use trend lines to see if the interventions are having the desired results of increasing identification of co-infected patients. URC/QAP will visit each facility/CBO/HBO at least twice a month to provide onsite mentoring to staff. This will focus on improving skills of staff in TB screening/treatment as well as ensuring that improvement plans are being implemented correctly. During these visits URC/QAP will review program performance data.
Activity 4: Building Sustainability
URC/QAP will train district and facility-level supervisors in QA methods and facilitative supervision techniques for improving the quality of TB/HIV coordinated activities at facility and community-levels. To address the short-and long-term human resource needs to manage the enormous burden of HIV-infected TB patients, URC/QAP will work with CBOs/HBOs and health care facilities to provide DOTS supporters in order to improve follow-up of co-infected patients as well as provide home-based care for these patients. URC/QAP will also conduct quarterly assessments in each facility/CBO/FBO to assess whether staff is in compliance with national guidelines.
Activity 5: Plus up funds will expand assistance with TB/HIV activities in all URC/QAP-supported facilities within the 5 provinces. URC/QAP staff will be involved in the dissemination and implementation of the TB/HIV infection control policy guidelines within all facilities and home-based and faith-based organisations supported by URC/QAP.
URC/QAP will assist PEPFAR in reaching the vision outlined in the USG Five-Year Strategy for South Africa by facilitating the expansion of HIV CT to high risk groups (TB patients) and increasing recognition of TB in PLHIV. URC/QAP work contributes to the PEPFAR goal of providing care to 10 million people affected by HIV.
This University Research Co., LLC / Quality Assurance Project (URC/QAP) activity in the counseling and testing (#7432) activity is linked to activities in PMTCT (#7431), Basic Health Care and Support (#7429), TB/HIV (#7430) and ARV Services (#7428).
University Research Co., LLC/Quality Assurance Project (URC/QAP) will work in 130 South African Department of Health (DOH) facilities in five provinces to improve the quality of voluntary counseling and testing (VCT) services through training, mentoring and introducing quality assurance (QA) tools and approaches. The essential elements of QA support include assuring technical compliance with evidence-based norms and standards, improving interpersonal communication and counseling, and increasing organizational efficiency. The major emphasis area for this activity is quality assurance/supportive supervision with minor emphasis on development of network/linkages/referral systems, training and needs assessment. The activity targets public health workers, community-based organizations (CBOs), faith-based organizations (FGOs), program managers, community volunteers, children, youth, adults, family planning clients and pregnant women.
URC/QAP has been supporting DOH facilities in five provinces (Eastern Cape, KwaZulu-Natal, Limpopo, Mpumalanga and North West) to improve CT services. The focus of this activity has been on improving counseling skills, as well as better integration of CT in several high-volume services. South Africa continues to face major problems in increasing VCT uptake among high-risk groups. Stigma, as well as fear of knowing one's HIV status, remains primary reasons for low uptake of VCT. In addition, most men do not visit health centers unless they are very sick, resulting in a low number of men requesting VCT. URC/QAP will increase the awareness about VCT among communities by creating linkages between public and community-based facilities, and strategies that involve men will be actively promoted. Social mobilization and public awareness will be improved by integrating HIV and AIDS services with other high volume and problem-prone health services, including antenatal, outpatient, and sexually transmitted infection services.
URC/QAP will carry out four separate activities in this Program Area.
URC/QAP will work with facilities to identify a core team representing staff from various clinical services. The facility-based teams, with support from URC/QAP and DOH staff, will be responsible for plans for improving access to and quality of VCT services. Each facility team will conduct a rapid baseline assessment where it has not already been completed to identify quality gaps in current VCT services. These assessments, using QA tools, will be used by the facility teams to develop and implement the quality improvement plan.
URC/QAP will assist facility teams in developing strategic plans for improving access to and quality of CT services. VCT services will be linked with high-volume and problem-prone services, such as TB, STI, and antenatal services, which have large proportions of HIV-infected clinic attendees. URC/QAP will also integrate routine HIV testing services, thereby increasing access to CT in all clinical settings. Emphasis will be placed on increasing recruitment of couples and families, including children and adolescents, to CT services. Facility staff will promote access and availability of confidential HIV testing, ensure that HIV testing is informed and voluntary, ensure effective and prompt provision of test results for all clients who undergo HIV testing, utilize a prevention counseling approach aimed at personal risk reduction for HIV-infected persons and those who have a higher risk of HIV exposure. URC/QAP will ensure that all facility staff are aware that HIV prevention counseling should focus on the client's unique personal circumstances and risk, and counseling should help the client set and reach an explicit behavior-change goal to reduce the chance of acquiring or transmitting HIV.
ACTIVITY 2: Human Capacity Development
Staff will receive QA training which will include specifics on CT quality, the meaning of quality in services and compliance with national guidelines. Emphasis will be placed on the indicators used to monitor clinical performance, such as the presence of guidelines at facility level or the knowledge and skills of counselors. Specific case studies will be used, and participants will work in groups to identify quality gaps and suggest possible solutions. URC/QAP will provide job-aids such as wall charts to improve compliance with clinical and counseling guidelines.
URC/QAP will visit each facility and CBO/FBO at least twice a month to provide on-the-job support and mentoring to healthcare workers in participating facilities. The mentoring will focus on improving skills of CT and other high-volume clinical service staff on HIV counseling and referring. During these visits, URC/QAP will also review program performance data.
ACTIVITY 3: Referrals and Linkages
URC/QAP is working on a continuum of care model for all HIV-infected persons, which emphasizes the identification and early referral of all people living with HIV (PLHIV) to care, treatment, and other support services. As part of this mandate, URC/QAP works to link different levels of care (facility, CBO, FBO, home-based organization (HBO)) and different services to minimize missed opportunities. To ensure that CT is widely available, various innovative CT approaches -- such as family-based, door-to-door, community-based, outreach services, youth focused and within home-based care -- will be incorporated into existing programs. URC/QAP will continue to expand this focus and promote available methods for prevention for all clients, including a specific focus on discordant couples. In addition, URC/QAP will continue to work with local CBOs and FBOs to increase community outreach and support for knowing one's HIV status. URC/QAP will train facility, CBO and FBO staff in analyzing their performance (outputs) and quality (compliance) indicators. The staff will use site-specific data to see if the interventions are increasing uptake of basic healthcare and support services on a monthly basis.
ACTIVITY 4: Building Sustainability
URC/QAP will train district and facility-level supervisors in QA methods and facilitative supervision techniques for improving the quality of CT services. URC/QAP has begun the process of reviewing the national VCT guidelines and evaluating the quality of VCT at facility level, in partnership with the provincial health departments at all levels. This will be a key focus area in the next 12 months. To ensure the quality and reliability of data obtained at all QAP supported sites, it has been necessary to ensure uniform reporting structures, with the introduction of QAP-specific data collection tools. These tools are utilized only by URC/QAP staff, as DOH facility staff have their own reporting registers which are facility and district specific.
URC/QAP will conduct quarterly assessments in each facility/CBO/FBO to assess whether the staff are in compliance with the NDOH VCT guidelines. At least once a year, sample-based surveys will be done in a small number of QAP and non-QAP sites to assess the differences in compliance and other performance indicators.
URC/QAP will assist PEPFAR in reaching the vision outlined in the South Africa Five-Year Strategy by increasing access to VCT services. URC/QAP work contributes to the PEPFAR goal of providing care to 10 million people affected by HIV.
This University Research Corporation/Quality Assurance Project (URC/QAP) activity in ARV Services is linked to activities in PMTCT (#7431), TB/HIV (#7430), Basic Health Care & Support (#7429) and Counseling and Testing (#7432).
Through training, mentoring and the introduction of quality assurance (QA) tools and approaches, URC/QAP will work with 35 South African Department of Health (DOH) antiretroviral therapy (ART) sites in 5 provinces (Eastern Cape, KwaZulu-Natal, Limpopo, Mpumalanga and North West) to improve provider and patient compliance with ART treatment guidelines and will improve the delivery of quality services to HIV clients. The essential elements of QAP support include technical compliance with evidence-based norms and standards, interpersonal communication and counseling and increasing organizational efficiency. The major emphasis area for this activity is quality assurance/supportive supervision, with minor emphasis on training, development of network/linkages/referral systems and needs assessment. The activity targets public and private health care workers, CBOs, NGOs, program managers, community volunteers, PLHIV, and HIV-affected families.
URC/QAP is currently training healthcare providers in 15 DOH ART service delivery sites in the use of QA tools and approaches for increasing compliance with ART guidelines. URC/QAP has developed a number of QA tools for healthcare facilities offering ART services. URC/QAP will increase the number of DOH ART-accredited facilities that it supports in the five provinces to improve the quality of care provided to all clients on ART. To strengthen HIV and AIDS services at facility level, URC/QAP plans to enhance community-based support for ART patients to ensure treatment adherence and active facility-based quality improvement using QA tools and approaches. In addition, URC/QAP will hire sessional medical staff in facilities in the 5 provinces to provide ART services. These providers will serve as mentors to DOH staff. This strategy will create local capacity to provide treatment services over time. URC/QAP will assist healthcare facilities to develop operational strategies to improve the care, treatment and follow-up of children and adolescents on ART. URC/QAP will also capacitate local community-based organizations (CBOs) and home-based care organizations (HBOs) to integrate QA tools and approaches for improved quality of their home-based follow-up of ART patients.
Activity 1: Establish Facility-level Quality Improvement Teams
URC/QAP will work with NDOH facilities to identify a core team representing staff from ART and other service providers. Based on a review of better practices, the facility-based teams, with support from URC/QAP coordinators and other district staff, will be responsible for developing and implementing plans for improving the quality of ARV services as well as the continuum of care for patients on ART. Each facility team will conduct baseline assessments to identify quality gaps in current services for screening, treating and following up people living with HIV (PLHIV) on ART. These baseline assessments will be used to implement required changes and address any identified gaps in service delivery.
URC/QAP will assist facility teams in developing and implementing strategic plans for expanding access to and improving the quality of ART services, in line with national guidelines. The key elements of the plan will include training, infection control and prevention, patient information, nutrition support and counseling, community involvement, follow-up system at treatment and other levels of care, use of data at facility level, and monitoring and evaluation of the program.
Additional ART service providers and other staff will receive training in the provision of
high quality ART services in FY 2007. URC/QAP will strengthen the supervision and support systems at district and provincial levels. In addition, URC/QAP will provide job-aids/wall charts to improve compliance with clinical and counseling guidelines. URC/QAP will also work with facility staff, CBOs/HBOs and PLHIV associations to develop strategies for identification and referral of defaulters as well as provision of treatment support to PLHIV on ART in their community, reducing loss of clients to follow-up. URC/QAP will visit each DOH facility/CBO/HBO at least twice a month to provide onsite mentoring and support to staff.
URC/QAP will assist staff to provide family-centered and pediatric ART services. Within existing ART programs there is an identified need to strengthen pediatric ART care. In FY 2007, URC/QAP will expand these programs to ensure that ART accredited sites are capacitated to incorporate pediatric care and treatment into existing ART programs. Training will be provided to facility staff to ensure that ART programs are family-centered, enabling parents, children and other dependents to have access to HIV care and treatment services. In addition, emphasis will be placed on training facility staff to recognize the value of wellness programs for PLHIV, of which prevention with positives (PWP) is a key component. Wellness programs are essential to ensure that PLHIV not eligible or ready for ART are retained within the health system to enable regular follow-up and review of client ART eligibility. URC/QAP is developing linkages with these NDOH ART programs to target health facilities and HBO programs for adherence support. This process will continue in FY 2007, with expansion at QAP-supported facilities within all 5 priority provinces. Finally, URC/QAP will train facility and CBO/HBO staff in analyzing performance and quality indicators.
URC/QAP will recruit physicians and nurses to provide ART services at facilities in 5 provinces, this will increase the human capacity available at each facility and increase the number of HIV clients that are able to receive ART and other services. These providers will serve as mentors to local DOH clinical staff.
URC/QAP will continue to train district and facility-level supervisors in QA methods and facilitative supervision techniques to improve the quality of ART services. URC/QAP has contributed to the development of the continuum of care for PLHIV policy document currently under development by the NDOH and will continue to support its development and implementation. URC/QAP will conduct quarterly assessments in each DOH facility, CBO, and HBO to assess compliance with national ART guidelines.
Activity 4: Referrals and Linkages
URC/QAP will facilitate linkages to treatment for eligible PLHIV. All facility staff will be trained in national guideline compliance, QA methods specific to ART programs, and developing and implementing quality-specific improvement plans. These improvement plans include process redesign, integration of services, and enhancement of network development to improve referral patterns. URC/QAP has prioritized plans to strengthen the approach and referral of HIV-infected pregnant women and their infants from PMTCT programs to ART programs, with a well-functioning down referral system, and will continue to promote and expand these linkages. In addition, URC/QAP plans to strengthen linkages from OVC programs to routine maternal and child health services and ART programs. URC/QAP will also assist the DOH to scale-up best practices for ART referrals.
URC/QAP work contributes to the PEPFAR 2-7-10 goals by improving access to and quality of ART services.
